Provider Demographics
NPI:1063139731
Name:OLSON, SHARON R (LH00005691)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:R
Last Name:OLSON
Suffix:
Gender:F
Credentials:LH00005691
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 SAINT JOHN ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4173
Mailing Address - Country:US
Mailing Address - Phone:206-300-7605
Mailing Address - Fax:
Practice Address - Street 1:1065 SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4173
Practice Address - Country:US
Practice Address - Phone:206-300-7605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WA00005691101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health